When & How To Seek Medical Care
If low back pain lasts for longer than one to two weeks, seek medical care. First, make an appointment with your primary care physician.
Seek immediate medical attention if any of the following symptoms are present in addition to back pain:
- Severe abdominal pain
- Unexplained fever
- Loss of control of your bowels or bladder
Xiii Surgery For Lower Back Pain
Because the vast majority of patients recover from their low back pain with little help from a doctor, the rationale behind choosing surgery must be convincing.Eighty percent of patients with sciatica recover eventually without surgery.
Severe progressive nerve problems, bowel or bladder dysfunction and the cauda equina syndrome make up the most clear-cut indications for back surgery. Back surgery will also be considered if the patients signs and symptoms correlate well with studies such as MRI or electromyogram .
In the most serious cases, when the condition does not respond to other therapies, surgery may well be necessary to relieve pain caused by back problems. Some common procedures include:
- Discectomy removal of disc material that has herniated
- Spinal fusion a bone graft that promotes the vertebrae to fuse together
- Spinal laminectomy removal of the lamina to create more space and reduce irritation and inflammation
To get an in-depth look at surgical procedures for lower back pain, visit .
Finding Lower Back Pain Relief
Nearly everyone will experience some form of back pain in his or her lifetime. The low back is the area behind the belly from the rib cage to the pelvis and is also called the lumbar region. Back pain is a major cause of missed work. Low back pain usually resolves on its own and is commonly the result of a strain injury. There are many treatments for low back pain.
At Risk for Lower Back Pain?
Low back pain can start in a person’s early twenties and continue on throughout adulthood. Studies have shown that up to 80% of the general population are affected by low back pain at some time during their lives. Learn to prevent lower back pain by knowing what activities could be putting you at risk.
Common Causes of Low Back Pain
- Manual materials handling
- Twisting of the trunk
- Bending the trunk to the side
- Excessive reaching
- Extreme tallness
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Vii Fractures And Lower Back Pain
Fractures of the spine are often very difficult pain problems and indicate the possible presence of osteoporosis . In patients with severe osteoporosis, spinal fractures can occur with no early warning and no significant trauma the patient does not have to fall to fracture a vertebrae.
Patients with spinal compression fractures experience spasms and very high pain levels.
In patients with low back pain where the cause is difficult to determine, especially for elderly patients with osteoporosis, a fracture in the sacrum may be the cause of the pain. A standard X-ray or bone scan may not show a sacral fracture. Imaging techniques such as CT scan or MRI can often reveal these fractures.
It is very important that patients with acute lumbar compression fractures be tested for osteoporosis. A bone density study is needed, unless the patient has no other osteoporosis risk factors and has had a very high impact fracture. Studies have shown that many patients with fractures in the U.S. are discharged from hospitals with no plans for management of their bone density problems, which then are left to worsen.
Although pain can be very intense, it is best for patients with lumbar fracture to resume activity as soon as possible. This is especially true for elderly patients, who can too easily become weakened, and develop other complications, if mobility is reduced for too long. might be needed for pain control, for a brief period.
Lower Back Pain: What Could It Be
Do you have lower back pain? You are not alone. Anyone can experience lower back pain at any time, even if you dont have a prior injury or any of the risk factors. It is not always serious and can often get better on its own. But in some cases pain is your bodys way of telling you that something isnt right.
Learn more about lower back pain and what causes it from rehabilitation physician Akhil Chhatre, M.D., who specializes in back pain in the Johns Hopkins Department of Physical Medicine and Rehabilitation.
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Hot Or Cold Therapy For Low Back Pain
Hot or cold packs may help ease pain and reduce symptoms. The soothing relief from heat, or the dulling relief from a cold pack, is only temporary and will not treat more serious causes of back pain. However, they may provide greater mobility for people with acute, subacute, or chronic pain, allowing them to get up and get moving.
Symptoms Of Low Back Pain
These might range from a dull ache to a stabbing or shooting sensation. The pain may make it hard to move or stand up straight. Pain that comes on suddenly is âacute.â It might happen during sports or heavy lifting. Pain that lasts more than 3 months is considered âchronic.â If your pain is not better within 72 hours, you should consult a doctor.
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Muscle Strain And Ligament Sprain
A low back sprain or strain can happen suddenly, or can develop slowly over time from repetitive movements.
- Strains occur when a muscle is stretched too far and tears, damaging the muscle itself.
- Sprains happen when over-stretching and tearing affects ligaments, which connect the bones together.
For practical purposes, it does not matter whether the muscle or ligament is damaged, as the symptoms and treatment are the same.
Common causes of sprain and strain include:
- Lifting a heavy object, or twisting the spine while lifting
- Sudden movements that place too much stress on the low back, such as a fall
- Poor posture over time
- Sports injuries, especially in sports that involve twisting or large forces of impact
While sprains and strains do not sound serious and do not typically cause long-lasting pain, the acute pain can be quite severe.
Living With Lumbar Strain
Cold reduces swelling. Both cold and heat can reduce pain. Protect your skin by placing a towel between your body and the ice or heat source.
- For the first few days, apply an ice pack for 15 to 20 minutes.
- After the first few days, try heat for 15 minutes at a time to ease pain. Never sleep on a heating pad.
- Over-the-counter medicines can help control pain and swelling. Try aspirin or ibuprofen.
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Can Lower Back Pain Be Related To Weather
If you feel like your lower back pain worsens on days when its cold or the weather is changing, you are not imagining things. Back pain can indeed be related to barometric pressure and outdoor temperature. Changes in pressure can sometimes cause pain in arthritic joints, including the spine. Muscles and joints in general react to the environment, which can make them stiffer and more likely to suffer an injury.
Menstruation Or Uterine Dysfunction
Dysmenorrhea, a uterine dysfunction which is the origin of frequent and severe cramping for women during menstruation, also predisposes women to back pain. The condition is classified as either primary or secondary, and with both types, low back pain is a common symptom.
- Primary dysmenorrhea begins when a woman starts her period and perpetuates throughout her life. Its harsh and atypical uterine contractions can result in recurrent and severe menstrual cramping.
- Secondary dysmenorrhea usually begins later in life, and its caused by another condition such as endometriosis or pelvic inflammatory disease.
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Lower Back Pain: Is It In Your Genes
One of the main reasons a person develops low back pain and another doesn’t may lie in their genes. With disc degeneration, Andersson says, âIf you take twins — one who is doing heavy physical work and one who is doing desk work — and you compare their MRI exams, they are essentially identical. This tells you that genetic factors are very important.â
If you have chronic low back pain, you’ve likely inherited the tendency, and you’re probably hardwired for it. The lower back contains sensitive receptors called nociceptive fibers, which send pain signals to the brain. “Some people have a lot of nociceptive fibers — for example, in their discs — while others have relatively few,” Wisneski tells WebMD. That may be why one person can lift heavy weights many times and never experience low back pain, while another who barely lifts anything is in constant agony.
Symptoms Of Lower Back Pain When Walking
If youre experiencing pain in your lower back when walking, you may have felt some of these symptoms already.
Pay attention to what your back is telling you. What type of discomfort are you feeling? Is it dull pain? Is it shooting pain? Identifying the type of pain will help your doctor figure out whats going on.
Also, pay attention to where you feel the pain. Is it in one specific area? Is it acute pain that radiates across your lower back?
The type of pain and its location may help you and your doctor determine whats going on.
If you are experiencing lower back pain when walking, here are some pain symptoms you may be feeling:
- Stiffness
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Is Lower Right Or Left Back Pain Worrisome
Pain on one side of the back is not particularly more worrisome than central pain. There are three main kinds of one-sided back pain:
Most of the anatomy of the low back and abdomen is symmetrical. Some of the guts are not symmetrical, and only some of those is a plausible cause of back pain on one side. Heres some of the key anatomy to consider:
The side of the pain on its own doesnt tell us much, and most of the one-sided sources of pain are viscera that usually cause abdominal pain instead of back pain, or in addition to it. In other words, the only reason to worry about right or left lower back pain is if it is otherwise worrisome: if you have other red flags or significant non-back symptoms.
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When To Worry About Low Back Pain
And when not to! Whats bark and whats bite? Checklists nd red flags and non-scary possible explanations for alarmingly back pain
The bark of low back pain is usually much worse than its bite. The pain almost always makes it seem worse than it is. Even when its unusually severe and/or constant, it probably isnt dangerous.
MRI and x-ray for low back pain are surprisingly unreliable,1 because things like bulging discs usually arent a big deal,2 most back pain goes away on its own,3 and trigger points are common and can be worrisomely intense but arent dangerous.4 Most patients are much better off when they feel confident about these things. The power of justified, rational confidence is a huge factor in back pain.5 Sadly, many healthcare professionals continue to perpetuate the idea of fragile backs,6 which undermines that valuable confidence.
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What Research Is Being Done
The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world.
As a primary supporter of research on pain and pain mechanisms, NINDS is a member of the NIH Pain Consortium, which was established to promote collaboration among the many NIH Institutes and Centers with research programs and activities addressing pain. On an even broader scale, NIH participates in the Interagency Pain Research Coordinating Committee, a federal advisory committee that coordinates research across other U.S. Department of Health and Human Services agencies as well as the Departments of Defense and Veterans Affairs.
What Can Cause Lower Back Pain
Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back fit together and move. Some examples of mechanical causes of low back pain include:
Congenital
- Skeletal irregularities such as scoliosis , lordosis , kyphosis , and other congenital anomalies of the spine.
- Spina bifida which involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.
Injuries
- Sprains , strains , and spasms
- Traumatic Injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate.
Degenerative problems
- Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability.
- Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
- Arthritis or other inflammatory disease in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.
Nerve and spinal cord problems
Non-spine sources
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Other Conditions That Cause Back Pain In Older Adults
We often see a range of less serious but still painful spine conditions in seniors. Most patients with these conditions will not require surgery. Physical therapy, medication, injectable anesthetics, or a combination of treatments usually can control symptoms.
- Degenerative disc disease, which can cause whole spine pain, and lumbar arthritis, which usually causes low-back pain, commonly develop with age and are considered wear-and-tear conditions.
- Sacroiliitis is an inflammation of the joints that connect your spine and pelvis. This condition can cause pain in the low back, glutes, and upper legs.
- Ankylosing spondylitis is an inflammatory arthritis that causes patients spines to become inflexible, resulting in a continual hunched forward position and spine pain.
- We also check for adult degenerative scoliosis and kyphosis, spine-curving conditions that can result in back pain and weakness in the lower extremities.
Is It Time For Back Surgery
Back surgery is often a last resort when all other treatment options have been tried. Surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression resulting from vertebrae shifting or collapsing.
Back surgeries often have a long recovery period, and some patients may lose mobility and flexibility post-surgery. It is also important to note that not all surgical procedures are successful. As such, it is important for patients to talk with their physicians and know all of the risks associated with a procedure before undergoing back surgery.
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What Are The Risk Factors For Developing Low Back Pain
Anyone can have back pain. Factors that can increase the risk for low back pain include:
Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. Loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.
Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. Weekend warriorspeople who go out and exercise a lot after being inactive all weekare more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.
Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.
Genetics: Some causes of back pain, such as ankylosing spondylitis , have a genetic component.
Smoking: It can restrict blood flow and oxygen to the discs, causing them to degenerate faster.
Backpack overload in children: A backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue.
You’re Having Problems With Your Bowels Or Urination
If your back pain is paired with a loss of control over your bowels or urination, then it’s time to seek help immediately at a . These symptoms point to cauda equina syndrome, where the nerves in the lower spine have become paralyzed. While rare, this syndrome can be permanently damaging to the nerves if left untreated. If you experience these symptoms, especially accompanied by numbness in the legs, then you may need surgery to decompress the nerves and preserve their overall function.
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